598 129__130


Endoscopic insertion of esophageal self-
expandable antireflux metal stents is a
widely used procedure. The implantation
is usually regarded as safe, with a low rate
of complications. Here we report two
cases of spontaneous fracture of Hanaro
(M. I. Tech Co., Ltd., Seoul, South Korea)
antireflux stents.
A 69-year-old patient with metastasized
stenosing Barrett’s carcinoma received a
Hanaro stent (ref HEV-18-160-070; lot
no. 07061422) at the University Hospital
of Leipzig in August 2007. In January
2008, upper gastrointestinal endoscopy
revealed complete fracture of the distal
third of the stent and dislocation of the
distal part of the stent into the antrum,
which had caused a prepyloric ulcer
(l" Fig. 1). Both fragments of the stent
were removed immediately by endosco-
py (l" Fig. 2). Eight days later, a replace-
ment stent (ref HEVT-22-120-070; lot no.
07081314) was implanted without fur-
ther complications.
A similar stent (ref 1-ECF-22120-Z070; lot
no. 08021228) was implanted in a 72-
year-old patient with metastasized distal
esophageal carcinoma at St Mary’s Hospi-
tal, Berlin, in May 2008. Peritrast swallow
showed regular placement of the stent
(l" Fig. 3). Two months later, a contrast-
enhanced computed tomography (CT)
scan was taken at the University Hospital
CharitØ, Campus Benjamin Franklin, Ber-
lin. The scan showed an incomplete frac-
ture in the proximal third of the stent
(l" Fig. 4). Both fragments of the stent
were removed immediately by endos-
copy.
Fracture of an esophageal stent is a rare
event. A Medline search revealed only
five reports of six patients. The authors
of these reports suggested that the frac-
tures were caused by thermal overstrain
induced by laser application [1] or defec-
tive material [1, 2], or that they were
spontaneous [3 – 5]. All the stents used in
the above reports were self-expandable
metal stents without an antireflux valve
and were constructed from different ma-
terials (mostly nitinol) and obtained from
different companies. To our knowledge,
we report the first two incidents of frac-

Fracture of a covered self-expanding
antireflux stent in two patients with
distal esophageal carcinoma

Fig. 1 Endoscopic view of: a the distal fragment of the fractured stent; and b an ulcer in the pre-
pyloric antrum.

Fig. 2 Distally
fractured stent after
removal.

Fig. 3 Peritrast swallow after placement of the antireflux stent. a Regular passage of contrast medi-
um. b Functional antireflux valve.

UCTN – Unusual cases and technical notes E129

Wiedmann M et al. Self-expanding antireflux stent fracture … Endoscopy 2009; 41: E129 – E130

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tured antireflux esophageal stents. We
recommend including stent fracture as
potential complication in patient consent
forms.

Endoscopy_UCTN_Code_CPL_1AH_2AD

M. Wiedmann1, 2, F. Heller3, M. Zeitz3,
J. Mössner1
1 Division of Gastroenterology, Depart-

ment of Internal Medicine, University of
Leipzig, Germany

2 Department of Internal Medicine I,
St Mary’s Hospital Berlin, Germany

3 Department of Gastroenterology,
Infectious Diseases, and Rheumatology,
CharitØ, Campus Benjamin Franklin,
Berlin, Germany

References
1 Schoefl R, Winkelbauer F, Haefner M et al.

Two cases of fractured esophageal nitinol
stents. Endoscopy 1996; 28: 518 – 520

2 Grimley CE, Bowling TE. Esophageal metallic
stent dysfunction: first reported case of
stent fracture and separation. Endoscopy
1999; 31: S45

3 Reddy AV, Alwair H, Trewby PN. Fractured
esophageal nitinol stent: report of two frac-
tures in the same patient. Gastrointest En-
dosc 2003; 57: 138 – 139

4 Chhetri SK, Selinger CP, Greer S. Fracture of
an esophageal stent: a rare but significant
complication. Endoscopy 2008; 40 (Suppl
2): E199

5 Dogan UB, Egilmez E. Broken stent in
oesophageal malignancy: a rare complica-
tion. Acta Gastroenterol Belg 2005; 68:
264 – 266

Bibliography
DOI 10.1055/s-0029-1214661
Endoscopy 2009; 41: E129 – E130
� Georg Thieme Verlag KG Stuttgart · New York ·
ISSN 0013-726X

Corresponding author
M. Wiedmann, MD
Department of Internal Medicine I
St Mary’s Hospital
Gallwitzallee 123 – 143
12249 Berlin
Germany
Fax: +49-30-76783425
Wiedmann@marienkrankenhaus-berlin.de

Fig. 4 Three-dimen-
sional computed
tomography (CT)
reconstruction of the
proximally fractured
stent.

UCTN – Unusual cases and technical notesE130

Wiedmann M et al. Self-expanding antireflux stent fracture … Endoscopy 2009; 41: E129 – E130

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